The Sustainability Of National Health

September 29, 1999

A new report questions the sustainability of Britain's National Health Service (NHS) in its present form. Without changes, the NHS will have to levy higher user charges and increase rationing, says the report published by the Nuffield Trust and Cambridge University's Judge Institute of Management Studies.

The report says rationing could take two forms: 1) more treatments may be restricted to certain categories of patients, and 2) whole services may be excluded from the NHS altogether -- just as dentistry, optical care and long-term care of the elderly are partially excluded at present.

Among the points made in the report:

Pressure on the NHS will grow because of the increasing number of elderly people who will have to be supported by a smaller work force, the pace of technological change and the public's rising expectations.

Public expectations in Britain are rising partly because of increased wealth but also because individuals have better access to health information, particularly electronic information, that was previously dependent on professional gatekeepers.

There is strong resistance in the United Kingdom to paying more taxes (the NHS is funded from general revenues), and other methods of increased funding for health care might have to be considered, such as a social insurance tax, medical savings accounts, more widespread use of private health insurance, or a combination of the three.

A final version of the report, incorporating feedback from health professionals and the public, will be presented to the prime minister in May 2000.